RU2462221C1 - Method of treating functional visual disturbances and device for its realisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions relate to medicine, namely to ophthalmology, and deal with methods and devices for treatment of functional visual disturbances, in particular, for prevention and treatment of refractive impairment of vision and training accommodation, including directly at the workplace when visually tense work is performed, as well as in case of distance vision. In accordance with claimed method patient is suggested to view objects through device which represents optic elements with changing refraction, made in form of aspheric lenses with geometric centres with zero refraction oriented in device in such a way that on one side from geometric centre refraction monotonously increases, and on the other side from geometric centre monotonously decreases, with periodic movement of visual axis along horizontal plane with relative to geometric centres with zero refraction of aspheric lenses, defocusing of objects on retina takes place, which causes change of accommodation tension for focusing object on retina, making it possible to obtain claimed technical result.

EFFECT: reduction of refractive impairment (disturbances of accommodation, development of myopia and pseudomyopia), reduction of asthenopia and level of visual fatigue.

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Description

The inventions, united by the unity of the inventive concept, relate to medicine, more specifically to ophthalmology, and relate to methods and devices for the treatment of functional visual disorders, in particular the prevention and treatment of refractive visual impairment and accommodation training.

A known method for the treatment and prevention of the progression of myopia by improving the blood supply to the eyeball and the effect on the ciliary muscle, in which the effect on the ciliary muscle is carried out using drug cycloplegia lasting from 7 to 14 days, then provide its maximum relaxation under visual load by individual selection of means of exposure with simultaneous exposure, allowing to reduce the stretching of the sclera, in particular, as a means of influencing the ciliary the th muscle is used to neutralize accommodation lenses during prolonged accommodation during prolonged work at a specific visual distance depending on the degree of refraction, either sedative therapy or psychotherapy aimed at eliminating personality conflicts is used as a means of influencing the ciliary muscle, sclera stretching is reduced by either reducing intraocular pressure, either by improving the microcirculation of the sclera, or by increasing the venous outflow from the vessels of the brain (see RF patent No. 2145827, IPC A61F 9/00, Application No. 97122340/14 dated 12.30.1997, published on 02.27.2000). The disadvantage of this method is that it does not provide opportunities for training accommodation directly during treatment.

A known method of treating nystagmus and amblyopia by spectacle correction using the optical system, in which corrective spectacle lenses are used as the optical system, on the inner surface of the glasses of which Fresnel prisms are applied in such a combination that the prismatic force of each subsequent prism increases stepwise in both directions from the intact the zone located in the center of the lens, depending on the largest angle of deviation of the visual axis of the eye from the fixation point in the extreme positions of the nystagmus, while glasses are worn daily for at least 2 hours, with a course of at least 3 months, in particular, Fresnel prisms with a power of 6, 10, 15, 20 and 30 prism diopters are used for treatment, the width of the intact zone located in the projection of the central zone of the pupil, is 1-3 mm (see, for example, RF Patent No. 2195233, IPC A61F 9/00, G02C 7/14, Application No. 20011113658/14 of 05.23.2001, published December 27, 2002). The disadvantage of this method is the inability to provide training accommodation.

A known method of training accommodation using interchangeable lenses. For training use minus and plus lenses. After correcting ametropia with appropriate lenses, a text reading starts at a distance of 0.33 m, then lenses are inserted into the test frame - 0.5 diopters, and then the lens power is increased with a step of 0.5 diopters, bringing the load to a submaximal value. Reading with each new glass lasts 3-5 minutes. Then the strength of the last minus glass is gradually reduced by 1.0 diopters, leaving each glass for 1 min. After that, they go on to attach positive glasses, the training is repeated in the same sequence. In total, they carry out 15-20 exercises (E.S. Avetisov, K.A. Matz. On the training of accommodation during initial myopia // Materials of the conference of ophthalmologists. - Ufa. - 1972. - P.166).

The disadvantage of this method is that it is time-consuming, treatment is carried out in courses of 2-3 weeks in an ophthalmic office with the involvement of medical personnel, requires separation of patients from study and work, which is not always possible, while training is carried out only with close vision.

Closest to the proposed one is a known method of “swinging” accommodation with distance vision, in which the patient is located at a distance of 5 m from the table to check visual acuity, training is carried out with optical correction of ametropia, the patient takes special holders with lenses of -0.5 diopters in both hands, puts it on the test frame and looks at the bottom rows of the table for 30 s, then takes holders with lenses +0.5 diopters and looks at the table for 1 min, while the fogging that happens at the beginning usually disappears by the end of the exposure Zaet, and the exercise is repeated for 8 minutes, the duration of the course is 15-20 days (Volkov V.V., Kolesnikova L.N. Bulletin of Ophthalmology, 1972, No. 1, p. 50 - prototype).

The disadvantages of this method are its high complexity, the duration of treatment carried out in an ophthalmic office equipped with special equipment (holders with lenses), while training is carried out for the further zone of clear vision.

The objective of the invention is to provide a method for the treatment of functional visual disorders directly at the workplace when performing visually-intense work, as well as with distance vision.

The problem is solved by achieving a technical result, which consists in reducing refractive errors (accommodation disorders, the development of myopia and pseudomyopia), reducing asthenopia and the level of visual fatigue.

The technical result is achieved in the proposed method for the treatment of functional visual disorders, including focusing objects on the retina, in which objects are focused on the retina through optical elements with variable refraction with periodic movement of the visual axis along the horizontal plane relative to the geometric center of the optical elements with zero refraction, in particular, focus objects on the periphery of the retina, or on the periphery and on the central zone of the retina.

A device for training accommodation, which can be used in ophthalmology for the treatment of functional visual disorders associated with impaired accommodation, in particular acquired and congenital myopia or hyperopia, strabismus, nystagmus, etc. containing a guide and a screen with a test object, in which the screen is equipped with a cartridge for mounting a test object and a carriage with a pusher made in one piece with the screen, and the guide is equipped with a support for contact with the patient's face, in particular, the cartridge nen in the form of a collet clamp, and test objects in the form of a blind sleeve with a test sign on the front side, the profile of the support is equidistant to the profile of the zygomatic bone of the face (see RF Patent No. 2038035, IPC АВВ 3/09, Application No. 4953659/14 of 28.06 .1991, published on June 27, 1995). The disadvantage of this device is the need for treatment involving medical personnel, separation of patients from school and work, which is not always possible.

A device is known that relates to the field of medical ophthalmological technology, intended for the treatment of functional visual disorders associated with impaired accommodation, namely, acquired and congenital myopia or hyperopia, presbyopia, nystagmus, etc., which allows to increase the effectiveness of treatment by protecting the eyes from distractions factors in the process of training exercises, as well as in the possibility of conducting training exercises without the use of special glasses, which eliminates additional material patient costs due to the fact that the device for training accommodation is additionally equipped with an element of concentration of visual attention on the test object in the form of a screen mounted motionless on the end of the guide in front of the support, in which a hole is made, located coaxially with the test object and an interchangeable lens installed in the hole of the fixed screen (see RF Patent No. 2131210, IPC АВВ 3/00, application No. 95119333/14 of 11/15/1995, published on 10/06/1999). The disadvantage of this device is the complexity of the design, treatment is carried out in conditions conducive to the development of instrumental myopia.

A device for optical exposure in ophthalmology is known, in the case of which two optical systems with parallel optical axes are installed, equipped with a quotation mechanism for changing the position of the optical axes by a small angle and center distance, each optical system contains an emitter connected to a controlled power source and containing an IR laser , the optical channel of which is connected through an optical addition unit to an optical unit for forming a field of illumination, with the possibility of placing an external radiation receiver for adjusting the radiation power is installed, in addition, the system includes an emitter programmer connected to a timer and a controlled power supply unit with an emitter power supply changing unit, the optical system also includes a reference programmer connected to a timer and through an LED of an optical addition unit with a device to create pulsed rapper operation, characterized in that each optical system is equipped with an integrated laser radiation receiver with variable feedback transmission coefficient, the output of the built-in receiver is connected to a controlled power source, and the input through a part of the optical channel to the emitter, the optical system is equipped with a current meter installed between the controlled power source and the emitter, which has feedback from the controlled power source, in addition, the optical the system is equipped with a temperature correction unit for comparing the average radiation power with a reference, and the comparison unit is installed between an external radiation receiver and a controlled power source, and its control output is connected to a built-in radiation receiver, the emitter programmer contains a unit for forming an adjustable emitter power frequency, which allows solving the problems of ensuring continuous or pulsed laser operation with a given pulse repetition rate and stabilizing the average laser radiation power and obtain a technical effect, which in expanding the consumer properties of the device and increasing the stability of the released radiation dose, and the medical effect, sistent with a pulsed treatment protocols that allows collectively increase the effectiveness of treatment (see. RF patent No. 2201180, IPC A61F 9/00, A61N 5/067, Application: 2001130950/14 dated 03.03.2000, published 03.27.2003). The disadvantages of this device are the complexity of the design of the device, the need for treatment on an outpatient basis with the involvement of specially trained medical personnel.

A device is known for creating comfortable conditions for the functioning of the visual apparatus in working conditions at close distances, for the primary prevention of accommodation spasm and the disorders caused by it: myopia, asthenopia, etc., made in the form of sphere-prismatic glasses with a spherical component + (1.0 +/- 0, 5) diopter and prismatic component 2.0 +/- 0.5 prdptr (see RF Patent No. 2177282, IPC A61F 9/00, Application No.2000128727 / 14 of 17.11.2000, publ. 27.12. 2010). The disadvantage of this device is that it is designed to relax the muscular system of the eye and does not allow for training accommodation of the eye.

A device for the prevention and treatment of eye diseases, made in the form of glasses for the prevention and treatment of visual fatigue syndrome, in which the lenses are mounted in a frame so that the apex-base lines of the prism are located on the Tabo scale in the meridians of 45 ° for the left eye and 135 ° for the right eye, while the end face L facing the ear arches is located at an angle α = 45 ± 44 ° upward to the horizontal axis, and the end face M facing the nasal support is located at an angle α = 45 ± 44 ° down to the horizontal axis (see RF Patent No. 2199987, IPC A61F 9 / 00, G02C 7/14, Application No. 99119787/14 of 11/15/1995, published on 10/06/1999). The disadvantage of this device is that it, acting on the external muscles of the eye, shifts the image of the object on the retina, without changing the focus and thereby not stimulating accommodation.

Known glasses for the prevention and treatment of visual fatigue syndrome and acquired myopia, in which the thickness of the end face “e” of the lens facing the upper edge of the rim of the frame of the rim is less than the thickness of the end of “m” facing the lower edge of the rim of the frame of the rim, while the lenses are installed in frame so that the apex-base lines of the lenses of the right and left eye are located symmetrically with respect to the vertical optical axis at an angle a _1.2 = 0-15 ° (see, for example, RF Patent No. 2203640, IPC A61F 9/02; G02C 7 / 14; A61F 9/02, with priority of 06/22/2000, published on 05/10/2002 3). The disadvantage of this device is that it, acting on the external muscles of the eye, shifts the image of the object on the retina, without changing the focus and thereby not stimulating accommodation.

Closest to the proposed is the well-known device SHURKIN-BERSHANSKY, which can be used in medicine, in particular in spectacle optics, designed for the prevention and treatment of functional visual impairment, optical correction and training of vision, containing optical elements having zones with different characteristics and a common a dividing line, while the optical centers of zones with different characteristics are in the same horizontal plane, and their dividing line is located so that it is provided the visual axis of the eye travels from zone to zone at any horizontal point, in particular, the optical centers of zones with different characteristics of one optical element are located on the same optical axis (see RF Patent No. 2110239, IPC A61F 9/00, G02C 7/08, Application No. 96123143 dated 12/04/1996, published on 05/10/1998 - prototype).

The disadvantage of this device is the appearance of double vision when fixing an object and an image jump when moving a gaze from one object to another, the probability of binocular vision impairment increases.

The objective of the invention is to provide a device for the treatment of functional visual disorders.

The problem is solved by achieving a technical result, which consists in reducing refractive errors (accommodation disorders, the development of myopia and pseudomyopia), reducing asthenopia and the level of visual fatigue. The claimed technical result is achieved in a device for the prevention and treatment of refractive vision disorders and accommodation training, including optical elements, in which aspheric lenses with a geometric center with zero refraction are selected as optical elements, oriented in such a way that on one side of the geometric center along the horizontal plane, the refraction is monotonously enhanced, and on the other side of the geometric center along the horizontal plane, monotonously about labevaet, in particular, the device is in the form of points representing a frame defined therein aspherical lenses.

Devices equipped with progressive lenses are known from the prior art (Olga Scherbakova “Progressive Lenses”, prepared according to the materials of Carl Zeiss, Veko # 8 (63), published on December 24, 2002 in the Medical Library on the server Medlinks.ru), in of which a smooth increase in refraction is achieved by the surface design, in which the radius of curvature gradually decreases both in the vertical and horizontal directions, the lenses have two stable vision correction zones: the upper one for the distance and the lower one for the near, the area between the zones for near and far, VK otor and there is an increase (progression) of refraction, called a “corridor” or a progression zone, and thanks to a smooth increase in refraction, the glasses wearer, lowering his eyes down for reading, uses a zone with higher refraction values, which is necessary for vision correction in this range, in peripheral zones located outside the “corridor” of progression, a gradual increase in distortion occurs, which cannot be completely eliminated, however, with modern progressive lenses, these distortions are so reduced what the user can notice only during the initial period of adaptation, while the above-mentioned source of information does not achieve the technical result, stated in the proposed inventions, united by the unity of the inventive concept, which consists in reducing refractive errors (accommodation disorders, the development of myopia and pseudomyopia), reducing asthenopia and level of visual fatigue.

The device is illustrated in graphic material, where Figs. 1-7 show embodiments of the proposed device for treatment, for the prophylaxis and treatment of refractive disorders of vision and accommodation training.

Figure 1 presents a front view of the proposed device, made in the form of glasses, which are a frame 1 with aspherical lenses installed in it (right - 2p and left 2l) with geometric centers of lenses 3p and 3l with zero refraction with a horizontal axis 4 of refraction change.

Figure 2 shows a front view of the device using spectacle frames 5 with holders 6p and 6l of aspherical lenses 3p and 3l, nose stop 7, while the holders 6p and 6l are made with the possibility of movement in the horizontal plane (shown by arrows), nose stop 7 is made with the possibility of vertical movement (shown by arrows).

Figure 3 shows the same as in figure 2, but a top view showing the clips 8p and 8l, the scales 9p and 9l, placed on the upper end 10 of the frame 5, designed to measure the distance of the holders 6p and 6l from the center of the nose stop 7 (mm), while the latches 8p and 8l are made with the possibility of movement in the radial direction (shown by arrows).

Figures 4-7 show curves 11p and 11l of the dependence of the change in refraction with distance from the geometric centers 3p and 3l with zero refraction, with the optical power (D) reflected along the vertical axis and the distance from the geometric center along the horizontal axis. Presented in FIGS. 4-7, the curves 11p and 11l of the dependence of the change in refraction are applicable to the devices shown in FIG. 1, FIG. 2.

A device in which the change in refraction corresponds to the curves shown in figure 4, is shown mainly for training distance and near vision for accommodation disorders in order to prevent the development of myopia and pseudomyopia.

A device in which the change in refraction corresponds to the curves shown in FIG. 5 is shown mainly for training distance and near vision for accommodation disorders.

A device in which the change in refraction corresponds to the curves shown in Fig.6, shown mainly for the prevention of asthenopia and visual fatigue during close-eye work.

A device in which the change in refraction corresponds to the curves shown in Fig. 7 is shown mainly for training distance and near vision, treating pseudomyopia and for preventing the development of myopia.

The device shown in figure 2, 3, is universal and can be used with various anthropometric data of patients.

Testing of the proposed method using a device for its implementation was carried out on patients aged 8 to 58 years with various types of refraction engaged in visually-intense work, while increasing the effectiveness of the training is achieved by the fact that the proposed method can be used regularly, as the patient exercises on its own, either during the whole working day to restore accommodation, or within 1-2 hours a day for the treatment of functional visual disorders, in particular, the profile tics of accommodative disorders in near and distance vision.

Example 1. Patient B., 25 years old, diagnosis: moderate myopia, accompanied by complaints of asthenopia, visual impairment in the distance, rapid fatigue when working close. Ophthalmic status before treatment: refraction - OD sph - 5.75 cyl - 0.50 ax 176, OS sph - 5.50 cyl - 0.25 ax 164, visual acuity without correction - OD 0.1 with sph - 5.75 cyl - 0.50 ax 176 = 0.7, OS 0.1 sph - 5.50 cyl - 0.25 ax 164 = 0.7, the margin of relative accommodation is 1.5 diopters. A treatment was prescribed in which the patient used the glasses shown in Fig. 1 and Fig. 6 for 2 hours and when examining objects through optical elements with variable refraction, made in the form of aspherical lenses 2p and 2l with geometric centers 3p and 3l with zero refraction (Fig. 1), oriented in the device in such a way that on one side of the geometric center 3p and 3l, the refraction is monotonously enhanced, and on the other side of the geometric center 3p and 3l, it monotonically weakens (Fig. 6), with periodic movement see axis along the horizontal plane 4 relative to the geometric centers 3p and 3l with zero refraction of aspherical lenses 2p and 2l, defocusing of objects arose on the periphery of the retina, which caused a change in the accommodation voltage to focus the object on the retina. The course of treatment was 2 weeks. Ophthalmic status after treatment: refraction has not changed, visual acuity -OD 0.1 sph - 5.75 cyl - 0.50 ax 176 = 0.8, OS 0.15 with sph-5.50 cyl - 0.25 ax 164 = 0.9, the stock of relative accommodation increased to 2.5 diopters, asthenopic phenomena disappeared.

Example 2. The same as in example 1, but using the device shown in figure 1 and figure 4, patient C., 32 years old, diagnosis: computer vision syndrome, accompanied by complaints of blurred vision after a long work with monitor. Ophthalmic status before treatment: refraction - OD sph -0.25 cyl -0.25 ax 105, OS sph + 0.25 cyl -0.5 ax 87, visual acuity OD 0.7 with sph -0.25 cyl - 0.25 ax 105 = 0.9, OS 0.8 with sph +0.25 cyl -0.5 ax 87 = 0.9, the margin of relative accommodation is 1.0 diopters. Ophthalmic status after treatment: refraction - OD sph 0.00 cyl -0.25 ax 104 OS sph +0.25 cyl -0.25 ax 83, visual acuity without correction - OD 1.0, OS 1.0, relative reserve accommodation increased to 2.0 diopters, no complaints.

Example 3. The same as in example 1, but using the device shown in Fig.1 and Fig.7, patient D., 8 years old, diagnosis: accommodation spasm, risk group for myopia, periodically subjectively senses blurred vision in the distance . Ophthalmic status before treatment: refraction - OD sph-0.50 cyl-0.50 ax 23, OS sph-0.50 cyl -0.25 ax 144, visual acuity OD 0.5 sph-0.50 cyl - 0.50 ax 23 = 0.7, OS 0.6 with sph -0.50 cyl -0.25 ax 144 = 0.8, the margin of relative accommodation is 0.5 diopters. The treatment was prescribed by the claimed method using the proposed device for its implementation (figure 1), which was carried out for 2 hours a day, while there was a defocusing of objects on the periphery of the retina and in the central zone of the retina, the course of treatment was 2 weeks. Ophthalmic status after treatment: refraction - OD sph 0.00 cyl + 0.25 ax 56, OS sph + 0.25 cyl 0.00, visual acuity without correction - OD 1.0, OS 1.0, the stock of relative accommodation increased up to 1.5 diopters, no complaints.

As a result, the treatment of the claimed method using the proposed device for its implementation, tested on 26 patients aged 8 to 58 years with various types of refractive disorders engaged in visually demanding work, in all cases allowed to reduce the level of refractive disorders, increasing not corrected visual acuity and reserves of relative accommodation, reducing asthenopia, the level of visual fatigue, increasing visual performance.

Inventions, united by the unity of the inventive concept, can be used in medicine, in the field of medical ophthalmic technology for the treatment of functional visual disorders, in particular the prevention and treatment of refractive disorders of vision and accommodation training, including directly at the workplace when performing visually intense work, as well as vision in the distance.

Claims (5)

1. A method of treating functional visual disorders, including focusing objects on the retina, characterized in that the objects are focused on the retina through optical elements with varying refraction with periodic movement of the visual axis along a horizontal plane relative to the geometric center of the optical elements with zero refraction. 2. The method according to claim 1, characterized in that the focus objects on the periphery of the retina. 3. The method according to claim 2, characterized in that the objects are focused on the central area of the retina. 4. A device for the treatment and training of vision, including optical elements, the optical centers of which are in the same horizontal plane, characterized in that as optical elements selected aspherical lenses with a geometric center with zero refraction, oriented in the device in such a way that on one side from the geometric center, the refraction is monotonously amplified, and on the other side of the geometric center is monotonously weakening. 5. The device according to claim 1, characterized in that it is made in the form of glasses, which are a frame with aspherical lenses installed in it.

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